从过程转向结果,转向高质量的慢性疼痛治疗措施
Christa Coleman1, Robert P Lennon2, Rose Hennessy Garza3
1Departments of Psychiatry and Behavioral Health and Anesthesiology and Perioperative Medicine, Penn State College of Medicine, Hershey, Pennsylvania. ORCID: https://orcid.org/0000-0003-4255-5592.
Journal of opioid management
|October 25, 2023
概括
错误地应用阿片类药物指南会伤害患者. 这项研究提出了以患者为中心的慢性非癌症疼痛 (CNCP) 治疗反应,安全性和坚持性的指标,超出了吗啡相当剂量 (MEDD) 的每日剂量.
科学领域:
- 疼痛管理 疼痛管理
- 临床指南 临床指南
- 以患者为中心的护理
背景情况:
- 2016年美国疾病控制中心 (CDC) 的阿片类药物处方指南被误解,导致过度强调吗啡等效每日剂量 (MEDD) 作为衡量成功的标准.
- 这种错误的应用导致了慢性非癌症疼痛 (CNCP) 管理中的无意的患者伤害.
- 需要更全面和以患者为中心的指标来评估治疗的有效性和安全性.
研究的目的:
- 审查现有的CNCP指南和患者偏好.
- 确定实用,以患者为中心的指标,以评估接受阿片类药物治疗的CNCP患者的治疗反应和安全性.
- 为符合指导方针的可执行措施提出框架.
主要方法:
- 对临床指南 (CDC),研究指南 (临床试验中的方法,测量和疼痛评估倡议) 和可实施性指南 (指南可实施性评估) 的审查.
- 在审查过程中包括患者确定的治疗目标.
- 综合发现,创建一组可操作的指标.
主要成果:
- 确定了三个领域的指标:治疗反应 (疼痛强度,功能,生活质量,总体变化印象),风险评估/安全 (MEDD,其他物质的联合处方,心理健康严重程度) 和坚持/过程 (治疗协议,尿液毒理学).
- 强调所有指标都应该是可决定,可执行和可测量的实现性.
- 强调了评估阿片类药物治疗的风险益处概况的重要性.
结论:
- 总结了与指导方针一致的,以患者为中心的,可实施的指标,用于评估阿片类药物治疗的CNCP的治疗反应,安全性和坚持.
- 这种方法可以在整个卫生系统中标准化计量数据的收集和报告.
- 通过标准化,以患者为中心的指标,可以优化接受阿片类药物治疗的CNCP患者的护理和治疗结果.
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